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Your Weight and Fortune

Posted Sep 03 2012 12:00am

I used to have the annoying habit of answering a question with a question. Once, a friend wanted to share one of those light bulb-changing manpower jokes that involved therapists. “How many therapists does it take to screw in a light bulb?” he asked. The answer was supposed to be just one, but only if it really wants to change. Instead of playing along, I raised one eyebrow and with my best therapist expression responded with my first thought: “How many do you think?” Fortunately, he was a good sport and laughed.

I think I’ve gotten better about it, and when I occasionally do slip back into my old ways it’s usually for a good teaching opportunity. For example, when my patients ask me how often they should weigh themselves I usually respond with, “What’s it to you?” Okay, not in so many words, but I do ask them to tell me why they want to know their weight. I know it might sound like a dumb question, but my goal is to get them to think about what the number on the scale really means to them.

At best, people regard their weight as a quick and simple indicator of whether their eating habits have gotten off-track by comparing their current weight with what has always been normal for them. That’s not a bad way to use the scale . They know what they usually weigh, and if they see an increase of a few pounds, it serves as an early warning sign to start paying more attention to their eating.

For many people, though, especially those who struggle with their eating, the number on the scale takes on a far more important and frankly worrisome meaning: it represents their Score of Personal Worth. It’s often taken as a sign of whether they’re literally measuring up. It’s a score of how successful they are at being in control of their weight, and by extension, their lives. Here’s how one blogger on the Weight Watchers website describes the feeling:

“I’m always on edge Friday nights before Saturday morning weigh-ins. I guess until I’ve had more losing weeks, I’ll feel that way. It’s always a surprise, for sure. Sometimes when I’ve been very, very good, I’ll gain. Sometimes when I’ve been very naughty, I’ll lose. It’s a little surreal…like the Zoltar wish machine from Big with Tom Hanks. Please, Zoltar, I wish to weigh less!”

Relying exclusively on weight to measure progress with behavior change can have a very real negative impact on your motivation because expectations are often unrealistic, and the results are therefore likely a surprise. What’s worse is that the surprise can have a negative effect regardless of whether the results are worse or better than expected. If it’s worse, the reaction may be to give up the belief that things will ever improve. If it’s better than expected, it can create the unwarranted confidence that you can eat as much as you want and still lose weight!

When I worked at a hospital-based weight management program, we would normally weigh clients before the therapy session. For the staff, it was just part of keeping good medical records and noting any changes. But when I saw how patients reacted I became increasingly concerned about how they really felt about that part of the routine and how it impacted them.

Often, they would appear apprehensive before stepping on the scale. In addition to taking off their shoes, they would typically remove light sweaters, silk scarves, jewelry, just about anything that might add an ounce or two to that dreaded number. Sometimes, they would ask me not to tell them the result while they either covered their eyes or stood facing away from the digital display.

My concern bordered on alarm when a patient, anxious but optimistic about the results, reacted with mute shock and then outright despair when it was not what she had expected. I spent most of the session helping her out of that emotional state before we even had an opportunity to discuss the outsized personal meaning her weight held for her. At that point I realized that people not only overvalue the information on the scale, but it may actually be undermining their efforts at behavior change.

Most misleading is the normal daily fluctuation in weight due to the body’s retention of water. This can cause a variation in weight of as much as three to five pounds in either direction that is irrelevant as a meaningful indicator of anything. This can be due to water that you recently drank, salt intake, menstrual cycles and numerous other causes.

Even when weight is calculated together with height, as in the Body Mass Index (or BMI) that is widely used in medicine, the information is at best incomplete and at worst misleading. The BMI score is used to determine weight classifications, such as underweight, normal, overweight, and obese. However, these numbers were based on population norms used in actuarial tables to underwrite life insurance policies, where it would serve as a red flag. If the BMI indicated that an individual’s BMI is higher than the norm, it may trigger a need to more closely evaluate the person’s health. The index was not intended to assess health risk for an individual, as it is commonly used today. It also does not account for bone density, body frame, or muscle mass, all of which can overstate the meaning of a higher than average BMI.

Simple weight reflects only behavior that was undertaken prior to stepping on the scale. It may be useful if it changed in direct response and proportion to the recent effort someone puts forward in changing their eating behavior, but that is not at all the case. As I discussed in the previous section about the weight-loss plateau, dietary changes can take a long time to be reflected in weight, and the correlation between cause and effect is not a straight line.

Most importantly, even a truly meaningful measure of the percentage of body fat is not under our direct control. On the other hand, our behavior is under our direct and exclusive control. Not only that, but the outcome of that control, lifestyle change, is immediate, and eventually does indeed have a profound impact on weight, health, and well-being.

The bottom line is that your weight alone does not carry the meaning usually ascribed to it – in what it says about our health, well-being, or appearance – and it’s certainly not a measure of our self-worth! So if you’re still wondering whether or not you should weigh yourself on a regular basis, I would say, what do you think?

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